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Abstract
Background
Urinary Chemokine (C–C motif) ligand 14 (CCL14) is a biomarker associated with persistent severe acute kidney injury (AKI). There is limited data to support the implementation of this AKI biomarker to guide therapeutic actions.
MethodsSixteen AKI experts with clinical CCL14 experience participated in a Delphi-based method to reach consensus on when and how to potentially use CCL14. Consensus was defined as ≥ 80% agreement (participants answered with ‘Yes’, or three to four points on a five-point Likert Scale).
ResultsKey consensus areas for CCL14 test implementation were: identifying challenges and mitigations, developing a comprehensive protocol and pairing it with a treatment plan, and defining the target population. The majority agreed that CCL14 results can help to prioritize AKI management decisions. CCL14 levels above the high cutoff (> 13 ng/mL) significantly changed the level of concern for modifying the AKI treatment plan (p < 0.001). The highest level of concern to modify the treatment plan was for discussions on renal replacement therapy (RRT) initiation for CCL14 levels > 13 ng/mL. The level of concern for discussion on RRT initiation between High and Low, and between Medium and Low CCL14 levels, showed significant differences.
ConclusionReal world urinary CCL14 use appears to provide improved care options to patients at risk for persistent severe AKI. Experts believe there is a role for CCL14 in AKI management and it may potentially reduce AKI-disease burden. There is, however, an urgent need for evidence on treatment decisions and adjustments based on CCL14 results.
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1 Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
2 Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
3 Department of Critical Care Medicine, Hospital Sant Pau, Barcelona, Spain
4 Intensive Care Department, Hospital Fernando da Fonseca EPE, Amadora, Portugal
5 Department of Intensive Care, Navarra University Hospital, Navarra, Spain
6 Department of Anesthesia, Critical Care and Emergency, IRCCS Policlinico San Donato, Milan, Italy
7 Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical Unversity Innsbruck, Innsbruck, Austria
8 Anesthesiology and Critical Care Department, Clinic University Hospital of Valladolid, Valladolid, Spain
9 Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
10 Anaesthetics and Intensive Care, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
11 Physiology and Functional Exploration Service, University Hospital of Strasbourg, Strasbourg, France
12 Department of Critical Care & Nephrology, King’s College London, Guy’s & St Thomas’ Hospital, London, UK
13 Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy
14 Critical Care & Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
15 Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, Belfast, UK
16 Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
17 Baxter Healthcare Corporation, Deerfield, IL, USA
18 Baxter Deutschland GmbH, Unterschleissheim, Germany
19 Critical Care Unit, Royal Surrey Hospital and School of Medicine, University of Surrey, Guildford, UK